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We Can’t Get Pregnant – What Now? Diagnosing Fertility Problems

If you’ve been trying to conceive for a year or more with no success, it’s time to call in expert help.

Exploring the issues preventing you from getting pregnant might feel a bit scary or overwhelming, but knowledge is power.

Once you get the ball rolling, your medical team will conduct a series of tests to establish any fertility issues.

In this piece, we’ll explain what happens next, so you know what to expect.

What we’ll be outlining:

  • The initial GP assessments
  • Why do you have blood tests for fertility issues?
  • Two types of ultrasounds and their diagnosis
  • What semen analysis can show
  • The benefits of a laparoscopy

Starting fertility treatment

Before we begin, we just want to acknowledge the emotions you may feel as you start your fertility treatment.

Some people might have relatively swift treatments to resolve any issues, whereas others may face a longer process.

Whatever your experience, please know that your feelings are valid, and we understand how difficult this process can be.

We spoke to our in-house fertility expert Louise Hinton – who is also on the Stork Fertility Service team – to demystify the next steps.

Your GP and your fertility treatment

Begin by booking an appointment with your GP so they can do an initial assessment of your reproductive health.

The NHS website states that the doctor may want to:

  • Establish BMI (Body Mass Index)
  • Do a pelvic examination
  • Check the testicles and penis to look for any lumps or abnormalities

Why do they need to check these?

Louise explains that these initial assessments will help to establish general reproductive well-being.

“Weight can be a really sensitive issue to talk about, but the problem with a high BMI is all down to the hormone balance in the body”. Louise says this can have a “knock on effect on ovulation and conception”. This is confirmed by a 2018 study.

“The pelvic exams are all about checking for any lumps or signs of obvious issues such as endometriosis, fibroids, or ovarian tumours in women.

“For men, the GP will look for any abnormalities on the testicles or penis that could impact their fertility.”

If there are any elements of the above which trigger sensitivity issues, please discuss with your healthcare professional. They are typically very accommodating to modifying the processes to make them as comfortable as they can for you.

Diagnosing infertility

If the consultations with your GP don’t present clear answers to what’s going on, it’s time to discuss the next steps such as a referral to a specialist fertility clinic.

From here several different tests will take place to help diagnose the causes of infertility.

Remember, the practitioners performing these exams are well-versed in the procedures and can guide you through any worries or embarrassment.

Let’s look at what happens next…

Female fertility blood tests

The next step will be to do some blood testing to check the ovulation status.

Blood tests are used to establish the level of sex hormones (including follicle-stimulating hormone, luteinising hormone, oestrogen, testosterone and progesterone) in your body, as well as your Anti-Mullerian Hormone (AMH) level.

Louise explains, “This is about getting a picture of the ovarian reserve to establish if ovulation is happening regularly.

“All these hormones play their part in successful ovulation, so if the tests bring up any issues, you can begin to investigate solutions.

“These tests can help medics diagnose conditions such as polycystic ovary syndrome (PCOS), which could be causing significant problems for conception.”

Testing for Chlamydia

Routinely both partners will be tested for chlamydia.

Often people with chlamydia will present no symptoms or have some that they mistake for another problem.

But chlamydia can impact fertility in both men and women.

Why does Chlamydia impact fertility?

Louise explains: “It’s an infection that can seriously damage the fallopian tubes, ovaries and uterus if left untreated.

“Chlamydia often leads to pelvic inflammatory disease (PID), which can cause life-threatening ectopic pregnancies, where the egg implants in the fallopian tubes, not the uterus.

“It also damages sperm quality and mobility. These factors will have a serious impact on the chance of conception.”

Ultrasound for infertility testing

Did you know…

There are two common types of ultrasounds to explore fertility issues?

You may be familiar with the transabdominal ultrasound, often used in pregnancy scans, but you will also have a transvaginal one.

During the transvaginal scan, a lubricated transducer wand is inserted into your vagina so the sonographer can access better imagery of your reproductive organs.

Both ultrasounds give a clear picture of what’s going on in your reproductive system.

What are they looking for?

Louise explains, “The sonographer will be checking all parts of the female reproductive system and their structure.

“They’ll be able to see the uterus, ovaries, fallopian tubes, vagina and cervix.

“They need to establish that there are no blockages in your fallopian tubes and that your ovaries and uterus are healthy.

“Ultrasounds will also help establish if there are any issues with the endometrial lining of the uterus, or if there are any fibroids or cysts.”

Semen analysis

The primary fertility test for male partners is a semen analysis.

Experts will take a sample of semen and test it to check for any problems with the sperm.

Louise explains, “Your medical team will want to see what the sperm count is and how quickly the sperm move.

“They’ll also be looking closely at the quality of the sperm, their size and shape, and if there is the right amount of seminal fluid.”

Testing the sperm

The Fertility Network UK explains precisely what the experts are looking for during semen analysis.

They explain: “It’s important that the sperm sample is kept warm and is brought to the laboratory for testing within one hour of production.

“After the sample volume has been measured, the following calculations are carried out:

  • The number of sperm per millilitre (ml).
  • The percentage of sperm moving and the graded quality of movement ranging from good motile sperm down to completely non-motile sperm.
  • The percentage of abnormal sperm.
  • The number of white cells in the sample is noted as this may indicate infection.

“There can be considerable fluctuation in the results between different samples, so a reduced semen analysis will always be checked with one or two repeat tests.”

Laparoscopy

In some cases, doctors may suggest a laparoscopy, a test requiring a general anaesthetic.

During the hospital admission, a surgeon will make a small incision close to the tummy button, use carbon dioxide gas to inflate the area for easier access, and pass a slim telescope through into the abdominal cavity.

The surgeon will then pass a dye injection into the uterus via the cervix to see if there are any blockages in the tubes.

Why a laparoscopy?

Louise explains, “A laparoscopy will give an even more accurate view of the pelvic organs than an ultrasound.

“They’ll be able to check the uterus, the ovaries, and the tubes for any signs of PCOS, endometriosis, fibroids and any other issues.

“Although it’s a more invasive procedure, it will allow the surgeon to identify many causes of infertility so action can be taken.”

The procedure lasts less than an hour, and the patient should be discharged on the same day. Recovery should take just a few days.

All test results can then be discussed and a plan for moving forwards can be made.

We hope this article has given you a clear idea of what to expect when you embark on a fertility journey.

These initial tests can help identify and diagnose the causes of infertility, although some patients require further investigations.

We know that infertility can be heart-breaking and painful for many who desperately want to be parents.

It’s our sincere hope that you can overcome any conception challenges and go on to have a happy, healthy baby.

Remember, there is help available regardless of your diagnosis. Please discuss any concerns you have with your healthcare professional. For general mental health support, we recommend the following organisations with immediate chatting facilities: 

This article has been reviewed by our Kari Health Experts and Editorial Board to ensure accuracy and reliability of the information presented. However, please note that the content provided is for informational purposes only and should not replace advice from your medical professional.

Did you enjoy this article? 

If so, you can read related Kari Health articles here: 

How To Maintain A Healthy Vagina

How to Take Care of Yourself During a Divorce

Five Things to Expect From Your Body Postpartum

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